Nine leading medical societies are calling for updated safety standards in fluoroscopy laboratories (catheterization, or "cath" labs) where clinicians who conduct minimally invasive procedures face both radiation exposure and orthopedic injuries from heavy protective equipment.
The new safety framework is called ALARA+, or "As Low and As Light as Reasonably Achievable," and a report outlining it addresses the dual occupational hazards linked to fluoroscopic procedures, according to Robert Riley, MD, chair of the think tank summit group that developed ALARA+ during the 2025 Society for Cardiovascular Angiography & Interventions (SCAI) Scientific Sessions in Washington, DC. The report was published March 24 in JSCAI, Heart Rhythm, JVIR, and JVS-Vascular Insights.
"How we think about radiation safety has been historically guided by the ALARA principle, or 'as low as reasonably achievable,'" Riley said in a statement released by SCAI. "But that approach has proven to be not safe enough for healthcare staff working in fluoroscopic labs. The new framework, ALARA+, calls for responsible protection strategies that are 'as low and as light as reasonably achievable' for the entire team."
Fluoroscopy is used to treat conditions such as heart attack, stroke, and vascular disease. Clinicians use real-time x-ray imaging to guide catheters and other devices through blood vessels to diagnose and treat disease without open surgery. These procedures improve patient outcomes and shorten recovery times, but they impart long-term occupational risks for those who perform them due to receiving thousands of low but repeated radiation doses over the course of their careers. To reduce exposure, clinicians often wear heavy lead or lead-equivalent protective garments that can weigh 15 lb to 20 lb -- and the strain of wearing them during long procedures contributes to chronic neck, back, and joint injuries.
In 2023, SCAI conducted an occupational health hazards survey and found that roughly two-thirds of interventional cardiologists reported musculoskeletal pain related to working in the cath lab or wearing radiation protection equipment and noted further that trainees may accumulate "higher exposure near the radiation source while developing procedural skills."
The report calls for the following actions to improve safety in fluoroscopy laboratories:
- Accelerate the adoption of modern radiation protection technologies, such as suspended, freestanding, or table-mounted shielding systems that reduce exposure without requiring clinicians to wear heavy protective garments.
- Expand real-time radiation monitoring to enable clinicians to receive immediate feedback and reduce exposure during procedures.
- Strengthen radiation safety and exposure reduction education and training for physicians, trainees, nurses, and technologists.
- Further develop technological innovation to protect all catheterization lab clinicians.
- Support regulatory and accreditation standards that promote safe fluoroscopy laboratory environments.
The new framework has been endorsed by the following nine organizations: The Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), the Alliance for Cardiovascular Professionals (ACVP), the American Society of Echocardiography (ASE), the Heart Rhythm Society (HRS), the Society of Interventional Radiology (SIR), the Society of NeuroInterventional Surgery (SNIS), the Society of Vascular and Interventional Neurology (SVIN), and the Society for Vascular Surgery (SVS).
ALARA+ is about "modernizing safety expectations, not creating new obligations," according to SCAI President Srihari Naidu, MD.
"We are calling for the acceleration of practical changes in technology, policy, and laboratory design so radiation exposure is minimized, and the physical toll of protective equipment is no longer treated as inevitable," he said in the society statement.
Access the full report here.
